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The Bone & Joint Journal
Vol. 104-B, Issue 8 | Pages 963 - 971
1 Aug 2022
Sun Z Liu W Liu H Li J Hu Y Tu B Wang W Fan C

Aims

Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries.

Methods

This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation.


The Bone & Joint Journal
Vol. 103-B, Issue 2 | Pages 366 - 372
1 Feb 2021
Sun Z Li J Luo G Wang F Hu Y Fan C

Aims

This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID.

Methods

A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.


Bone & Joint Research
Vol. 9, Issue 10 | Pages 675 - 688
1 Oct 2020
Shao L Gou Y Fang J Hu Y Lian Q Zhang Y Wang Y Tian F Zhang L

Aims

Parathyroid hormone (PTH) (1-34) exhibits potential in preventing degeneration in both cartilage and subchondral bone in osteoarthritis (OA) development. We assessed the effects of PTH (1-34) at different concentrations on bone and cartilage metabolism in a collagenase-induced mouse model of OA and examined whether PTH (1-34) affects the JAK2/STAT3 signalling pathway in this process.

Methods

Collagenase-induced OA was established in C57Bl/6 mice. Therapy with PTH (1-34) (10 μg/kg/day or 40 μg/kg/day) was initiated immediately after surgery and continued for six weeks. Cartilage pathology was evaluated by gross visual, histology, and immunohistochemical assessments. Cell apoptosis was analyzed by TUNEL staining. Microcomputed tomography (micro-CT) was used to evaluate the bone mass and the microarchitecture in subchondral bone.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_6 | Pages 1 - 1
1 Jul 2020
Xiong L Hu Y Ding F Shao Z Wang W Liu G Cai X
Full Access

The purpose of this study was to evaluate whether AGEs induce annulus fibrosus (AF) cell apoptosis and to further explore the mechanism by which this process occurs.

AF cells were treated with various concentrations of AGEs for 3 days. Cell proliferation was measured by the Cell Counting Kit-8 (CCK-8) and EdU incorporation assays. Cell apoptosis was examined by the Annexin V/PI apoptosis detection kit and Hoechst 33342. The expression of apoptosis-related proteins, including Bax, Bcl-2, cytochrome c, caspase-3 and caspase-9, was detected by western blotting. In addition, Bax and Bcl-2 mRNA expression levels were detected by RT-PCR. Mitochondrial membrane potential (MMP) and intracellular reactive oxygen species (ROS) production of AF cell were examined by JC-1 staining and DCFH-DA fluorescent probes, respectively.

Our results indicated that AGEs had inhibitory effects on AF cell proliferation and induced AF cell apoptosis. The molecular data showed that AGEs significantly up-regulated Bax expression and inhibited Bcl-2 expression. In addition, AGEs increased the release of cytochrome c into the cytosol and enhanced caspase-9 and caspase-3 activation. Moreover, treatment with AGEs resulted in a decrease in MMP and the accumulation of intracellular ROS in AF cells. The antioxidant N-acetyl-L-cysteine significantly reversed AGE-induced MMP decrease and AF cell apoptosis.

These results suggest that AGEs induce rabbit AF cell apoptosis and mitochondrial pathways may be involved in AGE-mediated cell apoptosis, which may provide a theoretical basis for diabetic IVD degeneration.


Bone & Joint Research
Vol. 5, Issue 10 | Pages 492 - 499
1 Oct 2016
Li X Li M Lu J Hu Y Cui L Zhang D Yang Y

Objectives

To elucidate the effects of age on the expression levels of the receptor activator of the nuclear factor-κB ligand (RANKL) and osteoclasts in the periodontal ligament during orthodontic mechanical loading and post-orthodontic retention.

Materials and Methods

The study included 20 male Sprague-Dawley rats, ten in the young group (aged four to five weeks) and ten in the adult group (aged 18 to 20 weeks). In each rat, the upper-left first molar was subjected to a seven-day orthodontic force loading followed by a seven-day retention period. The upper-right first molar served as a control. The amount of orthodontic tooth movement was measured after seven-day force application and seven-day post-orthodontic retention. The expression levels of RANKL and the tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts were evaluated on day 7 (end of mechanical force loading) and day 14 (after seven days of post-orthodontic retention). Statistical analysis was performed using the t-test, and significance was set at p < 0.05.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 14 - 14
1 Mar 2012
Kim W Hu Y Duan K Wang R Garbuz D Masri B Duncan C
Full Access

Introduction

Achieving durable implant–host bone fixation is the major challenge in uncemented revision hip arthroplasty when significant bone stock deficiencies are encountered. The purpose of this study was to develop an experimental model which would simulate the clinical revision hip scenario and to determine the effects of alendronate coating on porous tantalum on gap filling and bone ingrowth in the experimental model.

Methods

Thirty-six porous tantalum plugs were implanted into the distal femur, bilaterally of 18 rabbits for four weeks. There were 3 groups of plugs inserted; control groups of porous tantalum plugs (Ta) with no coating, a 2nd control group of porous tantalum plugs with micro-porous calcium phosphate coating, (Ta-CaP) and porous tantalum plugs coated with alendronate (Ta-CaP-ALN). Subcutaneous fluorochrome labelling was used to track new bone formation. Bone formation was analysed by backscattered electron microscopy and fluorescence microscopy on undecalcified histological sections.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 590 - 590
1 Nov 2011
LeBlanc JM Hutchison C Samad MD Su A Widmer A Hu Y Donnon T
Full Access

Purpose: Surgical trainees develop psychomotor skills using various techniques, with simulators providing safe practicing environments. There has been no development of virtual simulators with haptics (force feedback) that allow residents to practice the open surgical fixation of common orthopedic fractures. The main purpose of this study was to assess if residents performed similarly on a newly developed virtual simulator as on a Sawbones simulator using a modified checklist and global rating scale. Secondary purposes were to assess the reliability and validity of these procedural measurement tools.

Method: A stratified randomized within-subjects study was performed with 22 surgical trainee volunteers. They were randomized to first perform surgical fixation of the ulna using either the virtual or Sawbones simulator, and then performed the same procedure on the other simulator. Evaluators completed a task-specific checklist, global rating scale (GRS), total error score and time to completion for each participant on both simulators.

Results: The participants achieved significantly better scores on the virtual simulator compared to the Sawbones simulator (p0.8), except in time to completion. When combined, the checklist and GRS maintained high levels of internal consistency (Cronbach’s a > 0.80) and inter-rater reliability (intraclass coefficient > 0.90) for both simulators. A Pearson’s product moment correlation was used to demonstrate criterion validity of the measurement tools. They were all significantly correlated to each other within simulators (p0.9), while the virtual simulator achieved construct validity for the GRS and total error score (p1.1).

Conclusion: The modified procedural measurement tools demonstrate reliability and validity and the virtual simulator shows evidence of construct validity. These tools were used to evaluate participants, demonstrating the achievement of better scores on the virtual simulator compared to the Sawbones simulator. The only concern at this time is that the procedural measurement tool scores do not correlate between simulators. The newly developed virtual ulna surgical fixation simulator with haptics shows promise for helping surgical trainees learn and practice basic skills, but requires further modifications before it can attain the same standards as the current gold standard simulators.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 30 - 30
1 Mar 2010
Kim W Garbuz DS Hu Y Duan K Masri BA Rizhi W Duncan CP
Full Access

Purpose: Porous tantalum has been shown to be very effective in achieving bone ingrowth. However, in some circumstances, bone quality or quantity is insufficient to allow adequate bone ingrowth. We hypothesized that the addition of alendronate to porous tantalum would enhance the ability of porous tantalum to achieve bone ingrowth in these challenging situations, such as when a gap exists between the implant and bone. We evaluated the effect of alendronate coated porous tantalum on new bone formation in an animal model incorporating a gap between implant and bone.

Method: Thirty-six cylindrical porous tantalum implants were bilaterally implanted into the distal femur of 18 rabbits for 4 weeks. There were 3 groups of implants inserted; a control group of porous tantalum with no coatings, porous tantalum with micro-porous calcium phosphate coating, and porous tantalum coated with micro-porous calcium phosphate and alendronate. Subcutaneous fluorescent labeling was used to track new bone formation. Bone formation was analyzed by backscattered electron microscopy and fluorescent microscopy on undecalcified samples.

Results: The relative increase in mean volume of gap filling, bone ingrowth and total bone formation was 143% (p< 0.001), 259% (p< 0.001) and 193% (p< 0.001) respectively in the alendronate coated porous tantalum compared with the uncoated porous tantalum controls. The relative increase in the percentage of new bone-implant contact length was increased by 804% on average in the alendronate coated porous tantalum compared with the uncoated tantalum controls.

Conclusion: This study demonstrated the significant enhancement of bone-implant gap filling and bone ingrowth which can be achieved by coating porous tantalum with alendronate. It is proposed that, when faced with the clinical problem of revision joint replacement in the face of bone loss (at the hip, knee or elsewhere), the addition of an alendronate-delivery surface coating would enhance biological fixation of the implant and promote the healing of bone defects.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 296 - 296
1 May 2009
Kim W Hu Y Duan K Wang R Garbuz D Masri B Duncan C
Full Access

Introduction: Achieving durable implant–host bone fixation is the major challenge in uncemented revision hip arthroplasty when significant bone stock deficiencies are encountered. The purpose of this study was

to develop an experimental model which would simulate the clinical revision hip scenario and

determine the effects of alendronate coating on porous tantalum on gap filling and bone ingrowth in the experimental model.

Methods: Thirty-six porous tantalum plugs were implanted into the distal femur, bilaterally of 18 rabbits for four weeks. There were 3 groups of plugs inserted; control groups of porous tantalum plugs (Ta) with no coating, a 2nd control group of porous tantalum plugs with micro-porous calcium phosphate coating, (Ta-CaP) and porous tantalum plugs coated with alendronate (Ta-CaP-ALN). Subcutaneous fluorochrome labelling was used to track new bone formation. Bone formation was analysed by backscattered electron microscopy and fluorescence microscopy on undecalcified histological sections.

Results: The relative increase in mean volume of gap filling, bone ingrowth and total bone formation was 124 %, 232 % and 170 % respectively in Ta-CaP-ALN compared with the uncoated porous tantalum (Ta) controls, which was statistically significant. The contact length of new bone formation on porous tantalum implants in Ta-CaP-ALN was increased by 700% (8-fold) on average compared with the uncoated porous tantalum (Ta) controls.

Discussion: Alendronate coated porous tantalum significantly modulated implant bioactivity compared with controls. This study has demonstrated the significant enhancement of bone-implant gap filling and bone ingrowth, which can be achieved by coating porous tantalum with alendronate. It is proposed that, when faced with the clinical problem of revision joint replacement in the face of bone loss, the addition of alendronate as a surface coating would enhance biological fixation of the implant and promote the healing of bone defects.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 541 - 541
1 Aug 2008
Kim WY Hu Y Duan K Wang R Garbuz DS Masri BA Duncan CP
Full Access

Introduction: Achieving durable implant–host bone fixation is the major challenge in uncemented revision hip arthroplasty when significant bone stock deficiencies are encountered. The purpose of this study was 1) to develop an experimental model which would simulate the clinical revision hip scenario and 2) determine the effects of alendronate coating on porous tantalum on gap filling and bone ingrowth in the experimental model.

Methods: Thirty-six porous tantalum plugs were implanted into the distal femur, bilaterally of 18 rabbits for four weeks. There were 3 groups of plugs inserted; control groups of porous tantalum plugs (Ta) with no coating, a 2nd control group of porous tantalum plugs with micro-porous calcium phosphate coating, (Ta-CaP) and porous tantalum plugs coated with alendronate (Ta-CaP-ALN). Subcutaneous fluorochrome labelling was used to track new bone formation. Bone formation was analysed by backscattered electron microscopy and fluorescence microscopy on undecalcified histological sections.

Results: The relative increase in mean volume of gap filling, bone ingrowth and total bone formation was 124 %, 232 % and 170 % respectively in Ta-CaP-ALN compared with the uncoated porous tantalum (Ta) controls, which was statistically significant. The contact length of new bone formation on porous tantalum implants in Ta-CaP-ALN was increased by 700% (8-fold) on average compared with the uncoated porous tantalum (Ta) controls.

Discussion: Alendronate coated porous tantalum significantly modulated implant bioactivity compared with controls. This study has demonstrated the significant enhancement of bone-implant gap filling and bone ingrowth, which can be achieved by coating porous tantalum with alendronate. It is proposed that, when faced with the clinical problem of revision joint replacement in the face of bone loss, the addition of alendronate as a surface coating would enhance biological fixation of the implant and promote the healing of bone defects.